Key Trends in the Future of Medicine: E-Patients, Communication and Technology

by Dr. Bertalan Meskó on October 25, 2012

At the end of the 19th century, French artists were hired by a toy or cigarette manufacturer to create a series of postcards which would feature the future. Most of the postcards described ordinary processes and activities, but not medicine or healthcare. There might be only one example when they tried to predict the use of a microscope and the work of microbiologists:

This series of interesting postcards show how hard predicting the future of medicine is. As we must walk on the path of evidence based medicine, it’s a real challenge to predict the next technologies and solutions in healthcare. One thing is clear though: the real medical instrument will be the same, proper communication.

Robots replacing doctors?

I’ve given hundreds of presentations and I teach at several universities about the use of social media in everyday medicine and I always highlight the importance of 1) doctor-patient relationship in person, and 2) good communication skills for doctors, but if I try to think ahead, I have to agree with Vinod Khosla that technology can replace 80% percent of the work of doctors.

Khosla believed that patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. Google’s development of a driverless smart car was “two orders of magnitude more complex” than providing the right diagnosis.

IBM’s Watson is just the perfect example here. They have been working closely with oncologists at Memorial Sloan-Kettering Cancer Center in New York in order to see whether Watson could be used in the decision making processes of doctors regarding cancer treatments. Watson doesn’t answer medical questions, but based on the input data, it comes up with the most relevant and potential answers and the doctor has the final call. This is an important point as it can only facilitate the work of doctors, not replacing them.

The society of doctors is quite a closed one from many perspectives. Introducing new concepts is always tricky. Just think of how much they tried to avoid the expansion of the online world and then the denial that e-patients could be equal partners in the treatment. Medical professionals slowly accepted the advantages these concepts can bring into healthcare, therefore there is a reason to believe that the same will happen to automatic decision support systems as well.

Who will initiate the change?

Obviously, doctors can never be replaced totally by robots and the future of the patient-physician relationship is coded in the way healthy consumers take matters into their hands and lead the movement that transforms healthcare. We must not entirely rely on the society of medical professionals when it comes to changing healthcare any more, but e-patients initiate this process which is certainly going to be a strange new landscape for doctors who were trained for a paternalistic medical world.

So what should we expect to see in the next decades? I think we will see amazing developments in many areas, except medicine in which small and slow steps will mark the way towards a more transparent healthcare system in which decision trees are available for everyone, online content and social media are both curated, patients are empowered, doctors are web-savvy, and collaborative barriers are gone forever. A new world in which medical students are trained to be able to deal with the rapidly evolving technologies and e-patients.

As you can see, the aging society plays an important role in the future developments, but I would have loved to see prevention in this list. We should expect to see robotic and data-driven systems focusing on preventing diseases instead of treating them.

The next steps:

If technologically and medically well-trained doctors and empowered patients together with innovative technologies and evidence based big data systems league against diseases, we have a very good chance for winning this battle that has been going on for thousands of years.

Even if in this new world and especially in the near future, we will have new things to worry about such as medical terrorism, hacking medical devices or stealing patient data.

In a nutshell, there is a momentum in the history of medicine and we are living in the best era when we still have the opportunity to choose the path we will walk on. In case the path is marked by open minded people collaborating and crowdsourcing online in order to find solutions for medical problems, this path will lead us to a great new world.

Regarding Watson, I have a concern, and it’s a big one, about how MSK is using it: they’re teaching it their prejudices.

Amazing, huh?

At O’Reilly’s Health FOO last summer there was a great presentation by one of Watson’s “fathers,” and he said MSK specifically wanted Watson to NOT go roaming and find all kinds of unexpected info – they want it to only dish up from a specific view of the world!

If IBM’s going to let each individual institution do that – teach “their” Watson its own set of prejudices – then we can well envision an e-patient asking a second opinion from another Watson!

Bad news. To me the great potential of Watson was that it could FIND all kinds of info that the physician didn’t know existed – it could be an “automated expert ACOR member.” Instead, they’re telling it not to “think for itself.” Brilliant. They still believe in centralized authority.

And this is a sore point for me, because for some ancient reason, Memorial Sloan Kettering won’t tell patients about IL-2, the only drug that sometimes cures kidney cancer. So if I’d been a patient there, I wouldn’t have been offered it.

I’d really like to hear what senior MSK people say is the rationale for this. I do presume it’s because they believe their doctors are smarter than, and should thus vet, everything else in the world.

And how ironic that even with Watson in their hands, they failed to have the info that my ACOR kidney cancer *patient* community has, about the treatment that saved me.

Hi. Michael Holmes here. I am program director in IBM’s Watson Solutions group. Sorry to be late to the great conversation here. I appreciated the blog post and Dave, it’s good to be in contact with you again. Just a few points of clarification and an offer to respond to any questions. Dr. Mesko, thank you for emphasizing that Watson does not make decisions. It is being trained to give medical professionals a panel of suggestions, each of which has a confidence score associated with it as well as a transparent view of the evidence and references behind the suggestion. The work we’re doing with MSK focuses on cancer diagnosis, test recommendations, and treatment protocols is meant. The Journal of Clinical Oncology states that 20-44% of initial cancer diagnoses are incorrect so there is great opportunity for improvement. Watson’s recommendations are informed by a “data corpus” of curated information. During this training phase, this includes vast volumes of medical journals, text books, NCCN guidelines, and, yes, MSK documented best practices. No organization is perfect but MSK is widely recognized as one of the world’s leading authorities on cancer research and care. But Dave – I want to emphasize that individual medical professionals can choose to remove specific references and evidence sources (including MSK best practices) from consideration for any reason whatsoever. Medical professionals are the actors. Not Watson. With medical information doubling every 5 years and physicians’ being unable to keep up with the flood of new information, Watson is very likely to present information that an individual physician was previously unaware of. And unlike traditional technologies that underutilize unstructured data which makes up the 80% of the world’s data today, Watson understands plain language text. So Watson can co-evolve with the field as new evidence emerges and new treatment protocols are developed. We think of Watson as an early step into an era of Cognitive Systems capabilities that will play an increasingly important role in the way we live and work more broadly. It’s not an instant cure-all for all of healthcare’s challenges. Not even close. But it’s a bold step forward (albeit a very small and preliminary step) to overcoming some significant challenges.

Thank you very much for the explanation, it certainly made many things clear. I would love to do a short interview with you about how Watson helps oncologists, if you are open to that.

Basically the reason why people expect much from Watson is that they tend to overestimate its capabilities. We should know more about the role it is supposed to play in the near future of medical decision making.

I hope you’re going to publish your results and some details about the project soon so we can spread the word about it for the public as well.

First, Michael, great to see you here, and thanks for the conversation! I completely agree that it would make no sense for IBM to get into the “decisions” business; I wouldn’t want to be within ten miles of any attorney the first time a decision was wrong, even if it happened a million times less than when humans do it.

I’d relish the link to that journal piece saying 20-40% of first cancer diagnoses are wrong – as you know, I don’t attack the establishment, I make the case for everyone working together to improve.

Re “individual medical professionals can choose to remove specific references and evidence sources” – I get that – it just means that Watson per se will never be a trusty source of the best latest information, unless you also offer us (the patient community) an unfiltered (dare I say uncensored, or uncut?) Watson.

I’m quite serious, as you know – patients who are desperate NEED to know all the options, and since Jeopardy (before IBM announced the move into medicine) I’ve thought “That’s it! Automated ACOR!” in the sense of crawling the universe looking for things that are far from being published.

If that’s not what Watson is to be, then so be it – but I urge you to consider a “Watson: Raw and Uncut Edition.” Perhaps as a library assistant??

I also apologize for being late to the conversation. I am currently in a class where we discuss the influence of media and technology on the practice of medicine, and I was thrilled when I found this post. Your analysis of the future of medicine essentially summarizes the core concepts that we have been discussing all semester.

I particularly found your hypotheses in “Who will initiate the change?” insightful. You made a valid point that the field of medicine will be slow to change but that it ultimately will be forced to succumb to the rapidly changing technology that will inevitably shape how medicine is practiced. A key point that you touch on is the importance of training a new generation of medical students. This is extremely important. I think a lot of people focus on how technology is going to change the practice of medicine, but if we do not have a workforce filled with educated medical practitioners who are capable of understanding and using this technology to its fullest capacity, then the development of such technology is essentially useless.

I was also extremely impressed with the “Envisioning the future of health technology” figure. The “diagnostics” and “telemedicine” wedges are particularly relevant to the concepts we have been discussing in class. The idea that technology will one day be able to bring all the services of a doctor to a remote location outside of the doctor’s office is not new. Furthermore, the steps that have been taken in that direction have been large, and we are getting closer and closer to that goal everyday. My warning, and something that you did mention, is that such technologies cannot replace doctors but only facilitate their work. However, the average consumer is going to see these new technologies as a replacement for making doctor’s appointments and going into to get lab work done. So, my question to you is, how do you think this will impact the practice of medicine as we know it? Will doctors no longer have clinical offices? Will the doctor-patient relationship be forced to deteriorate to a certain extent?

All this and no mention of psychiatric disorders, which taken together have a lifetime incidence of more than 1 in 3 worldwide, are strongly genetically influenced, and are tremendously costly in across the spectrum of disease burden.

Thanks for the responses, all. They are much appreciated. By the way, there was a recent article in Fast Company that did a nice job going into a little more detail on Watson for Healthcare. Here’s the link. http://www.fastcompany.com/3001739/ibms-watson-learning-its-way-saving-lives. A few responses for your follow up questions:
Dr. Mesko, please let me know how to reach you and I’ll connect you with our media relations leader to discuss any follow up articles and interview.
Dave – source of 20-44% is Journal of Clinical Oncology, Talk about Health Blog, Sept 2011. But more importantly, let me make it clear that Watson and IBM are not and have never been in the business of withholding information from people. There is no “uncut” Watson that is then culled down for in-practice use. In the Jeopardy! era, Watson had a data corpus that was curated from sources like Wikipedia and IMDB. Considering that 90% of the world’s data was created in the past two years, there is no single source for all the world’s data… medical or otherwise. IBM works with partners to build a data corpus for a specific use case such as diagnosis and treatment of cancer… or more accurately, specific kinds of cancers such as lung cancer or breast cancer. There is no technical limitation on whether the sources of this data are published or unpublished. But just because a piece of information exists does not mean it winds up in a Watson data corpus. Other existing resources are better suited to act as comprehensive repositories (or as close to comprehensive as they can be) of medical information.
Priyanka- you may be interested in last week’s announcement about Cleveland Clinic students training Watson in areas of medical expertise. It’s well established that one of the best ways to learn is to teach. So I would view this as a symbiotic relationship: Watson and students co-evolving and in essence, teaching each other. Here’s the NYT’s account http://bits.blogs.nytimes.com/2012/10/30/i-b-m-s-watson-goes-to-medical-school/